Mental InJustice: Inmate's mental capacity restored

(The inmate in this story will be referred to by the pseudonym “Robert.”)

Watching him interact with his attorney and sheriff’s deputies before his court appearance, you’d never fathom the depths from which he came.

This bright-eyed, smiling defendant is articulate and inquisitive and appears as functional as any other inmate.

But five months ago, “Robert” was anything but functional.

He was a prisoner of his own mind in his solitary cell in the Lubbock County Detention Center after the homeless 51-year-old was arrested in April for breaking into a car to avoid the early spring chill.

Severely mentally ill and refusing medication, Robert constantly smeared himself with feces, and his songlike babbling was virtually unintelligible.

Keeping him clean was a daily struggle for detention officers, and people familiar with the case questioned whether he would ever become competent enough for his case to proceed. Butin November, Lubbock Countyfunded mental health staff at the jail to help inmatesbecome mentally competentafter Robert's condition was described in The Avalanche-Journal.

With court-ordered psychotropic medication and a diligent effort by jail and mental health workers, Robert underwent a profound transformation and is now awaiting release into the community. He pleaded guilty to criminal mischief and was sentenced to 200 days in jail. He had already served far more than that at the time of his plea, but agreed to stay in jail even after pleading guilty until officials could find a place for him to go.

Support determines success

“The changes that he evidenced and the recovery that he was able to achieve was remarkable and surpassed what I expected,” said Dr. Robert Morgan, director of forensic services at Lubbock Regional Mental Health Mental Retardation.

Experts agreed that remarkable though Robert’s progress may be, it will all be for nothing if he doesn’t have a support system in place when he leaves the jail.

“The bottom line is without help, he will be back how he was,” said Cathy Pope, chief executive officer at Lubbock Regional MHMR. “Obviously, if we don’t put enough supports around him, his opportunity for success is dramatically decreased.”

Ted Hogan, board president of the Lubbock Special Needs Defender’s Office, started a grassroots campaign to raise money and awareness to help Robert and people like him afford temporary housing and essential supplies while they wait for federal benefits to kick in because competency restoration is just the first step in an effective transition.

Medication stabilizes chemical imbalances in the brain and can be extremely effective, but other therapy is required if there is any hope of keeping a recently restored individual from deteriorating, Morgan said.

An individual’s success depends greatly on his or her understanding of the illness, its symptoms and how to manage those symptoms, Morgan said.

Some people won’t accept the fact they have a mental illness and will soon stop taking their medication when they leave jail.

Others don’t understand the necessity of the medication or can’t tolerate the severe side effects.

“A lot of individuals just don’t like the side effects. They’re so aversive that they’d rather try to manage their illness in other ways than with medication,” Morgan said. “Some people stay on the medication; some people don’t.”

The non-medical support is what makes the difference, Morgan said.

Special Needs Pod

Pope credits the Lubbock County Detention Center’s Special Needs Pod with helping get Robert stabilized.

Since Jan. 16, a psychiatrist and two mental health workers have been working with mentally ill inmates at the jail.

The MHMR staffers work with the University Medical Center counselors who had already established relationships with inmates, said Chris Menegay, a licensed professional counselor and mental health manager with UMC who works with special-needs inmates daily.

Even the jail staff received mental health training before the pod opened.

The pod focuses on psychotherapy, psychoeducation and helping inmates prepare to acclimate to society upon release, Menegay said.

He said the special-needs pod has been successful and has yielded some great results, challenging the inmates and educating them.

“Without the education, they’re not going to learn a whole lot,” Menegay said. “Most of the problems we have are those who come in jail, finally get established with the medication, get out of jail, and go right back to what they were doing before.”

That’s why it is important to get these now-patients into outpatient services and in steady contact with MHMR staff, Pope said.

However, Lubbock MHMR is currently overcapacity, and state-mandated cutbacks have hurt it even more, Pope said.

So with individuals like Robert, whose success hinges upon enrollment in outpatient services, MHMR has to give them priority forthose services.

Starting over with nothing

The first step, Pope said, is establishing a household. Many patients have nothing when they’re released from jail — no clothes, towels, dishes or toiletries.

Pope said she prefers to try to find long-term housing for newly released patients instead of sending them to shelters.

Many patients with special needs don’t function well in a group setting, such as the Salvation Army.

“The last thing we want to do is put them in a group setting for three days and then out on the street during the day,” Pope said. “That’s not really very conducive to a good transition.”

Some are fortunate enough to have a place to go back to — some semblance of a home life. Others are not so lucky, Pope said.

Robert is one of the not-so-lucky ones. He was homeless before he was arrested.

“If they were homeless, then they have nothing left,” Pope said.

That includes Social Security and Medicaid benefits.

If they were receiving benefits before they got locked up, they’ve lost them and must reapply. They can’t reapply until the day they get out, Pope said.

“If we could get benefits established before they leave jail, that would be a huge help,” she said.

If everything goes perfectly, they could start receiving benefits in about 30 days, Pope said. Sometimes it takes months.

Hoping for help

So Hogan has asked for donations to help address the problem.

He said $500 per month and donations of household items can typically bridge the gap until individuals like Robert start receiving benefits.

“We are setting up this fund to hopefully serve not only Robert, but the others like him that will certainly come our way in the future,” Hogan said. “We need to be prepared to handle these situations so that they have options available other than living on the street.”

Hogan said he hoped to raise enough money to keep a standing fund, only to be used in emergencies, as a cushion to fall back on when the system cannot adequately address the needs of newly released special-needs patients.

The fund would be a sound investment, considering the cost to taxpayers if Robert, or others like him, don’t have a safety net, Hogan said.

If they end up back on the streets, deteriorate to their prior mental state and end up back in jail, the costly process that took nearly a year for Robert would start again.

“Situations like these are like the old Fram oil filter commercials,” Hogan said. “You can pay a little bit now and fix the problem before it gets out of hand, or you can pay a lot to fix it later on.”

To comment on this story:

logan.carver@lubbockonline.com • 766-8704

shelly.gonzales@lubbockonline.com • 766-8747

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